1. Agents Used in the Treatment of Skin Conditions
Chapter 42
Agents Used in the Treatment of Skin Conditions

2. The Skin The largest organ Several functions
Protective barrier—microbials and trauma
Senses temperature changes
Secretes wastes through sweat glands
Stores fat
Synthesizes vitamin D
Provides a site for drug absorption

3. Basal layer is where new cells are formed Old cells migrate to surface
Epidermis
Outer layer
Thickness is variable
Basal layer is where new cells are formed
Old cells migrate to surface

4. Epidermis Prickle layer Protein projections connect adjacent cells
Cells become flat and press together
Compressed cells become the keratin layer
Keratin layer is the protective barrier

5. Dermis Thicker than the epidermis
Provides support and nourishment for the epidermis
Rich supply of blood vessels, nerves, sweat glands, and hair follicles

6. Eccrine and apocrine sweat glands
Structures of The Skin
Hair and nail tissue
Eccrine and apocrine sweat glands
Sweat contains water and waste products
Eccrine glands are located throughout the body

7. Emotional stimuli causes excretion of electrolyte solution
Skin structures
Apocrine glands are associated with a hair follicle – mainly in axillary and pubic areas
Emotional stimuli causes excretion of electrolyte solution

8. Sebaceous glands – connected to hair follicles
Skin Structures
Sebaceous glands – connected to hair follicles
Large numbers on head and face
At puberty, secretes oily mixture

9. Drug Classification of Dermatological Agents
Emollients
Keratolytics
Local anesthetic agents
Local antipruritic agents
Antibacterial agents

10. Emollients
Dry skin causes discomfort, itching, cracking, and predisposition to skin disorders
Treatment is use of emollients
Oily in nature: some skin lotions are emollients
Prevents loss of additional skin moisture

11. Emollients Forms occlusive barrier
Most contain waxes, fats, and/or oils
Most effective when applied after shower or bath
Do not use on skin lesions that are moist or exudative

12. Some disorders cause a thickening of the keratin layer
Keratolytics
Some disorders cause a thickening of the keratin layer
Skin becomes brittle and easily cracked
Causes itching and discomfort
Salicylic acid, lactic acid, and acetic acid

13. Keratolytics Applied after area has been bathed or soaked
More effective if covered with occlusive dressing
Kept on skin overnight; removed in morning
Repeated applications are effective

14. Local Anesthetics and Antipruritic Agents
Inhibits conduction of nerve impulses from sensory nerves
Reduces pain and itching
Used topically for insect bites, burns, and plant allergies

15. Local Anesthetics and Antipruritic Agents
Poorly absorbed through intact skin
Enhanced through damaged skin
Local or systemic adverse effects
Allergic reaction (locally or systemically)

16. Local Anesthetics and Antipruritic Agents
Topical anesthetics should only be used when absolutely necessary
Avoid in patients with previous hypersensitivity reactions
Avoid in severely traumatized skin

17. Local Anesthetics and Antipruritic Agents
‘caine’ types
Ointment, cream, spray, liquid or gel forms
Some antipruritic products contain antihistamines
Can be associated with development of local irritation and hypersensitivity reactions

18. Treats superficial infections Treat acne vulgaris
Antibacterial Agents
Prevents infection
Treats superficial infections
Treat acne vulgaris
Associated with development of hypersensitivity

19. Combination therapy is popular Caution when applying to large areas
Antibacterial Agents
Topical antibiotic agents are not usually ones that are used systemically
Combination therapy is popular
Caution when applying to large areas
Systemic effects may be possible

20. Drug Classification of Dermatological Agents
Antiviral agents
Antifungal agents
Anti-inflammatory agents
Antiparasiticidal agents

21. Antifungal Agents Treats two types of fungal infections
Dermatophyte organisms
Yeastlike organisms

22. Dermatophyte Infections
Caused by tinea or others
Most common is ringworm type
Circular pattern

23. Dermatophyte infections
Scalp, nails, and/or skin
Always superficial
May be known as ‘athlete’s foot’ or ‘jock itch’

24. Dermatophyte Infections
Can live only on dead keratin tissue
Affected area must be replaced with fungus-free tissue
Agents must be continued long-term

25. Dermatophyte Infections
Relapses common
Ointment, cream, aerosol, lotion, and powder forms
If burning or irritation develops, discontinue use

26. Dermatophyte Infections
Oral treatment may be effective
Deposits in newly formed skin cells
When new cells reach keratin layer, they are resistant to fungus
Best absorbed with or after a fatty meal
Monitor for hypersensitivity

27. Yeastlike Infections Involves warm, moist areas and mucous membranes
Moisture promotes yeast growth
Ventilation of area is important
Treatment should be continued for 1 week following lesion disappearance

28. Most difficult to treat Herpes simplex 1 and 2
Antiviral Agents
Most difficult to treat
Herpes simplex 1 and 2
Topical agents - cannot completely eradicate
Decreases healing time and pain

29. Topical, oral, or parenteral forms
Antiviral agents
Topical, oral, or parenteral forms
Topical form can cause burning, stinging, itching, or rash
Caution in patients with renal impairment
Monitor for hypersensitivity

30. Anti-Inflammatory Agents
Topically applied corticosteroids
Alleviates inflammatory symptoms
Irritation or allergic disorders
Useful in controlling psoriasis
Interferes with normal immunological responses
Reduces redness, itching, and edema
Slows rate of skin cell production

31. Anti-Inflammatory Agents
Effectiveness depends on potency of drug, vehicle used, skin thickness and integrity, and presence of moisture
Damaged skin may increase amount of drug absorbed systemically

32. Anti-Inflammatory Agents
Increases systemic side effects
Occlusive dressings increase absorption
Potent agents must be used with caution on thin skin
Do not use in the presence of fungal infection

33. Antiparasitic Agents Parasites live on outer surfaces Lice and scabies
Lice is transmitted person to person
Lives on head, body, or pubic area
Scabies is a mite; burrows under the skin and lays eggs
Drug of choice is lindane
Do not use in children under 2
Can cause seizures if applied to open skin
CNS toxicity

34. Additional Dermatologic Agents
Debriding agents
Antineoplastic agents
Burn treatment agents
Eczema agents
Psoriasis agents
Topical hair agents
Agents for diabetic foot ulcer

35. Leading cause of amputations
Diabetic Foot Ulcers
Leading cause of amputations
Microvascular and neurological changes due to long-term elevated blood sugar levels
Increases migration of cells responsible for wound healing to site of ulcer

36. Diabetic Foot Ulcers Needs adequate blood supply
Gel form helpful for protecting healing wounds
Long-term therapy required – Regranex promotes healing

37. Antineoplastic Agents
Destroys cells that grow rapidly
Topical treatment of solar or actinic keratosis
Premalignant skin lesions
Develops in fair skinned people exposed to heavy sunlight
Also used to treat basal cell carcinomas

38. Antineoplastic Agents
Use nonmetallic applicators
Protect skin with rubber gloves
Wash hands immediately
Avoid contact with eyes, nose, or mouth
Avoid exposure to sunlight

39. Agents Used to Treat Burns
Treatment aimed at preventing infection
Important to prevent toxic absorption into systemic circulation
Blood supply is impaired
Topical products may be only way to prevent infection

40. Agents used to treat burns
Occludes site to prevent contamination
Applied to burn after cleaning and debriding
Therapy continued until healing well or ready for grafts
Monitor for hypersensitivity and adverse effects

41. Minoxidil Systemically used as an antihypertensive
Topically promotes hair growth
Dilates local blood vessels
Long-term use
Caution with patients with heart disease
May cause tachycardia, fluid retention, and/or weight gain
Systemic effects more likely if applied to broken skin

42. Topical Debriding Agents
Purpose
Remove dead skin
Promote healing

43. Topical Debriding Agents
Made of enzymes
General action
Digest dead necrotic tissue
Specific action
Made of enzymes that digest:
Collagen: collagenase (Santyl)
Fibrin in a blood clot: fibrinolysin (Elase)

44. Debriding Agents Promotes removal of dead tissue
Removal of dead tissue enhances formation of new tissue
Wound healing occurs more quickly
Second- and third-degree burns and decubitus ulcers
Enzymes selectively digest dead tissue
Specific in action

45. Eczema S & S of acute or chronic conditions Area appears inflamed
Skin may be dry and may include wet or weepy drainage
Definition
Inflammatory skin condition. Symptoms are pustules, redness, vesicles, crusts, skin thickening, and persistent itching and burning.

46. Pimecrolimus (Elidel) Topical immunomodulator Adverse effects
Eczema
Drug agent
Pimecrolimus (Elidel)
Topical immunomodulator
Adverse effects
Site irritation
Headache

47. Agents Used to Treat Eczema
Eczema is a chronic inflammatory disease of the skin
Itching and scaling of the skin
Piecrolimus
- short-term and intermittent long-term use
- adverse effects include site irritation and
headache
Tacrolimus
- not a steroid
- adverse effect is an increased risk for skin infections

48. Psoriasis A chronic skin condition
Consists of painful reddened papules that form plaques with distinct borders
Other patches appear as silvery yellow-white scales
Usually located
Elbows, scalp, knees, and genitalia
Amevive (alefacept)
Raptiva (efalizumab)

49. Psoriasis Drug agent Alefacept (Amevive) Immunosuppressant
Stops the activity of T lymphocytes
Given intramuscularly
Adverse effects
Infection

50. Agents Used to Treat Psoriasis
Psoriasis is an autoimmune chronic skin disorder
Plaques on the skin – itching, bleeding, cracking
Alefacept – promotes longer remissions
Efalizumab – stimulates body’s immune response

51. Agents used to treat burns
Topical medications more effective if blood supply to area damaged
Aim to prevent infection without systemic absorption of toxins
Silvadene
Sulfamylon
Furacin

52. Topical Application Methods
Depend on the etiology of the skin problem
Require thorough cleansing of the skin before the agent is applied or reapplied
Must be applied appropriately or the agents will not work

53. Nursing Considerations
Perform thorough skin assessment
Minimize factors that promote skin drying in the elderly
Instruct in proper use of topical medications
Be aware that occlusive dressings may increase absorption

54. Nursing Considerations
Good hygiene is important
Assess for symptoms of infection
Administer medications according to guidelines
Teach diabetic patient the importance of foot care and daily assessment